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MSK > Lower Extremity MSK > Flashcards

Lower Extremity MSK Flashcards

1
Q

What is an Apophysis?

A

Normal development

- an outgrowth of a bone which arises from a separate ossification center, and fuses to the bone later in development.

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2
Q

Apophysis after forms an important insertion portion for what?

A

A tendon or ligament

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3
Q

Apophysis is most often mistaken for what?

A

Fractures

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4
Q

Are fractures generally perpendicular or parallel to diaphysis?

A

Perpendicular

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5
Q

Are apophysis generally perpendicular or parallel to diaphysis?

A

Parallel

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6
Q

What are the 2 MC locations for an apophysis?

A

Knee and Foot

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7
Q

Apophysis usually occurs at what age range?

A

14-18

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8
Q

How do you distingush a Jones fracture from other foot fractures?

A

More distal on diaphysis

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9
Q

What is the diaphysis?

A
  • Shaft of long bone

- elongation occurs toward epiphysis

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10
Q

What is the epiphyseal?

A
  • Growth plate

- Site of elongation of long bones

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11
Q

What is the epiphysis?

A
  • Terminal end of long bone

- Ultimately forms articular cartilage

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12
Q

What is a Sesamoid?

A

A bone that ossifies within a tendon

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13
Q

What is the largest sesamoid in the body?

A

Patella

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14
Q

Sesamoids are MC found where?

A
  • 1st MTP and 1st MCP
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15
Q

Sesamoid(s) are commonly referred to as what?

A
  • Mouse or Mice
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16
Q

History should include what characteristics?

A
  • Pain
  • Mechanical sxs
  • Joint effusion
  • Mechanism of injury
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17
Q

What is one of the MC causes of knee pain in active adolescents?

A

Osgood-Schlatter disease

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18
Q

Osgood-Schlatter disease affects what?

A

Apophasis of proximal tibia

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19
Q

What is the age range and MC gender of Osgood-Schlatter disease?

A
  • 11-15
  • M>F (males older at initial presentation)
    (bilateral 25-50%)
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20
Q

What is the etiology of Osgood-Schlatter disease?

A

Micro avulsions caused by repeat reaction on the anterior portion of developing ossification center of the tibial tuberosity

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21
Q

What are S/Sx of Osgood-Schlatter disease?

A
  • Discomfort with resisted knee extension
  • stair-walking/climbing and squatting
  • pain over tibial tuberosity
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22
Q

Sunrise view/skyline view XR looks at what?

A

Area under patella

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23
Q

What are the angles of Sunrise view/skyline view XR?

A
  • XR device is at 15 degrees

- Knee is at 115 degrees

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24
Q

What are the general tx options?

A
  • Conservative
  • decrease activities
  • RICE
  • NSAIDs
  • PT
  • surgery: rarely indicated
  • Othro referral: dx uncertain and persistent sxs
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25
Q

Ankle sprains are Mc’ly d/t what?

A

Inversion during plantar flexion involving lateral ligaments

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26
Q

Are isolated injuries to the medial ligaments common or uncommon and involve what?

A
  • Uncommon

- Involve a medial malleolar fracture

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27
Q

Thomsons test is used to assess Achilles rupture but can be misleading, why?

A
  • Partial tear may be present which means ankle can still move slightly
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28
Q

A high index of a talar dome fx is warranted when the pt presents with what sxs?

A

Chronic swelling and/or locking of ankles 4-5 wks post-injury

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29
Q

Do kids often sprain a joint?

A

NO- they fracture

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30
Q

Is fibular a weight bearing bone?

A

No- not weight bearing

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31
Q

A buckle or torus fracture is often d/t what?

A

FOOSH

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32
Q

An open growth plate is indicative of what?

A

A younger pt

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33
Q

What is a sprain?

A

Stretch and/or tear of a ligament

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34
Q

Ligaments connect what?

A

Fibrous bands of connective tissue that connect bone to bone

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35
Q

What is a strain?

A

Injury of a muscle and/or tendon

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36
Q

Tendons connect what?

A

Fibrous structures attaching muscles to bone

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37
Q

High ankle sprain often involves what?

A

Soft tissue ligament tears not seen on XR

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38
Q

What are the lateral ligaments?

A
  • Anterior talofibular ligament (ATL)
  • Calceneoufibular ligement (CL)
  • Posterior talofibular ligament (PTL)
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39
Q

What is the medial ligaments?

A

Deltoid ligament

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40
Q

The pt will often hear what when they fracture of fifth metatarsal?

A

Hear a pop

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41
Q

What are some special maneuvers for ankle injuries?

A
  • Anterior drawer test
  • Tilt test
  • Thompson test
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42
Q

Osteomyelitis is commonly seen in what?

A

Open injuries or recent surgeries

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43
Q

Reiters is often caused by what?

A

STD- Chlamydia

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44
Q

What are the specific sites for traumatic fractures?

A
  • Calcaneal
  • Tibia
  • Fibular
  • Metatarsal
  • Tarsals
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45
Q

What are some common traumatic fractures?

A
  • Stress Fx
  • Avulsion Fx
  • Interosseous Fx
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46
Q

A mortise view is used to identify what?

A

Uniformities in talar dome (able to see dislocation better)

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47
Q

What are the routine ankle views?

A
  • Lateral
  • AP
  • Mortise
48
Q

What are the routine foot views?

A
  • AP
  • Oblique
  • Lateral
49
Q

Lateral malleolus fracture involves what bone?

A

Distal Fibula

50
Q

Medial malleolus fracture involves what bone?

A

Distal Tibia

51
Q

Posterior malleolus fracture involves what bone?

A

Posterior prominence of Tibia

52
Q

Bimalleolar fractures involve what bones?

A
  • Both distal Tibia and Fibula

- Unstable ankle fx’s

53
Q

Trimalleolar fractures involve what bones?

A
  • Three fx involving both Tibia and Fibula

- Unstable ankle fx’s

54
Q

What are some signs of Trimalleolar fractures?

A

Cold to the touch, no cap refill, and decreases pulses.

55
Q

A fifth metatarsal fx is usually located where?

A

The base of 5th MT

56
Q

Lisfrancs fx is located where and usually caused by what?

A
  • Mid-Foot fx

- Kickball or kicking walls

57
Q

Syndesmotic injury are also called what?

A

High ankle sprain

58
Q

Syndesmotic injury are usually a result of what?

A

Ankle eversion and step and twist

59
Q

Syndesmotic injury involves ligaments attaching to what?

A

Ligaments attaching distal tibia and fibula

60
Q

Syndesmotic injury may or may not be associated with what?

A

Actual fracture, but is treated as a fracture

61
Q

On an XR of a Syndesmotic injury what is often seen?

A

Widening between fibular and tibula

62
Q

On an XR for a Lisfranc fx what is often seen?

A
  • Bones are pushed sideways and displaced laterally

- widening between big toe and 2nd toe

63
Q

What is a type 1 injury?

A

Ligament stretched or minor tear

64
Q

When can someone return to play with a type 1 injury?

A

1-10 days

65
Q

What is a type 2 injury?

A

Partial ligament tear

66
Q

When can someone return to play with a type 2 injury?

A

2-4 wks

67
Q

What is a type 3 injury?

A

Complete ligament tear

68
Q

When can someone return to play with a type 3 injury?

A

5-8 wks (ortho call is needed)

69
Q

What is a do not miss diagnosis in adolescents with hip pain?

A

Slipped capital femoral epiphysis: d/t risk for AVN

70
Q

What are historical findings of Trochanteric Bursitis?

A
  • Single blow or friction from IT band.
  • Predisposing factor: hx of training changes or increased Q angle.
  • MC bursitis.
  • “snapping hip” syndrome
71
Q

What are PE findings for Trochanteric Bursitis?

A
  • Pain to lateral aspect of the hip that is made worse w/ direct pressure over the bursa.
  • Well localized.
72
Q

What is the largest sesamoid bone in the human body?

A

Patella w/ quadriceps tendon

73
Q

What does PRICE stand for?

A 
P: protect the joint
R: Rest
I: Ice
C: Compression
E: Elevate
74
Q

AP view of the knee is helpful in diagnosing what?

A
  • Arthritis in the knee joint between the thigh and shin bones.
  • It can also show whether there is arthritis in the inside or outside of the knee
75
Q

Lateral view of the knee is helpful in diagnosing what?

A

Most useful for diagnosing arthritis between the kneecap and the thigh bone.

76
Q

Skyline view of the knee is helpful in diagnosing what?

A

Looks between the kneecap and helpful for diagnosing arthritis

77
Q

What are the radiologic characteristics of a Jones fracture?

A

Transverse orientation, involves the inter-metatarsal articulation
- Fracture of the proximal diaphysis of the 5th metatarsal

78
Q

What are the radiologic characteristics of a 5th metatarsal fx?

A

Transverse or oblique orientation, shaft of the bone-distal to inter-metatarsal joint,

79
Q

What structures are involved in a Lisfranc injury?

A

Midfoot and tarsometatarsal joint

80
Q

What are the 3 common Lisfranc injury patterns?

A
  1. Homolateral
  2. Isolated
  3. Divergent
81
Q

Homolateral (Lisfranc injruy) involves what structures?

A

All 5 MT (or 2-5)

- displaces laterally

82
Q

Isolated (Lisfranc injruy) involves what structures?

A

1 or 2 MT displaced

83
Q

Divergent (Lisfranc injruy) involves what structures?

A

-2-5 displaced laterally while the 1st MT is displaced medically

84
Q

What is the workup for a Lisfranc injury?

A
  • FWB: XR w/ comparison view = CRITICAL

- If XR normal but high suspicion: MRI or CT

85
Q

What are the 6 Ps for compartment syndrome?

A
  1. Pain
  2. Pallor
  3. Paresthesia
  4. Paralysis
  5. Pulslessness
  6. Pain out of proportion
86
Q

What are the clinical findings of compartment syndrome?

A

Increased pressure in closed muscle compartment

  • 3 compartments in thigh
  • 4 in lower leg
87
Q

What is the tx for compartment syndrome?

A
  • Orthopedic emergency (>40 mmHg)

- Surgical fasciotomy within 4-6 hrs

88
Q

What causes Slipped capital femoral epiphysis?

A
  • Weakened epiphyseal plate of femur

- displaced femoral head

89
Q

What is the classic patient of Slipped capital femoral epiphysis?

A
  • Male
  • 10-16
  • Obese
90
Q

What is the workup for Slipped capital femoral epiphysis?

A

Frog leg lateral pelvis or lateral hip view

91
Q

What is the treatment for Slipped capital femoral epiphysis?

A

Pinning and non weight bearing

92
Q

What are some risk factors for nonunion?

A
  • Fracture stability
  • Blood supply (inherent soft tissue damage, smoking, DM, vascular disease)
  • Nutrition
93
Q

AVN of the femoral head is also known as what?

A

“Leg Calve Perthes” in children

94
Q

What are S/Sxs of Leg Calve Perthes?

A

Dull ache and limp (x3-6 wks)

- aching pain in groin or proximal thigh

95
Q

What is seen on the hip XR in a pt with Leg Calve Perthes?

A

Crescent sign - resembles a subchondral fracture

96
Q

What is the tx for Leg Calve Perthes?

A
  • Long leg casts with spreader par (petrie casts) x 6 wks

- surgical: osteotomy

97
Q

When do strains occur?

A

Occur secondary to dynamic overload during eccentric muscle contraction

98
Q

What are the 2 types of hip fractures?

A

Intracapsular and Extracapsular

99
Q

Intracapsular hip fractures involved what structures?

A

Femoral head and neck

100
Q

Extracapsular hip fractures involved what structures?

A

Intertrochanteric/subtrochanteric

101
Q

What are characteristics of Intracapsular hip fractures?

A
  • Higher rates of nonunion, malunion, AVN
  • Common in older adults
  • Occurs 1-2 inches from joint
  • Risk to blood supply
102
Q

What are characteristics of extracapsular hip fractures?

A
  • Occurs 3-5 inches from joint

- Does not interrupt blood supply

103
Q

What are the weber classifications of a fibular fracture?

A
  • A: below syndesmosis
  • B: level of syndesmosis
  • C: above level of syndesmosis
104
Q

Hip fractures are more common in who?

A
  • Women > men

- White females > black or Hispanic females

105
Q

What are some causes of a hip fracture?

A

Falls

  • Direct blow
  • Osteoporosis (stand and twist)
106
Q

How will a pt with a hip dislocation be laying?

A
  • Leg internally rotated and adduction
107
Q

How will a pt with a hip fracture be laying?

A
  • Leg externally rotated and abduction
108
Q

Is a hip dislocation a medical emergency or no?

A
  • Medical emergency

- very rare

109
Q

What are PE findings of a hip disclocation?

A
  • Limp when walking
  • Shortening of leg
  • AROM is impossible
  • No attempt to reduce to prevent affecting vasculature, sensory and vascular check
110
Q

What is Piriformis syndrome?

A

Impingement of the sciatic nerve from spasm of piriformis muscles
- 6x more common in women

111
Q

In Piriformis syndrome where does the sciatic nerve pass under?

A
  • Passes under or through the piriformis muslces
112
Q

Piriformis syndrome mimics what?

A

Lumbar nerve root impairment and intervertebral disk disease

113
Q

What are the causes of Degenerative hip changes?

A
  • Age
  • Repetitive trauma
  • Acute trauma
  • Improper arrangement of hip
114
Q

What are the risks for Degenerative hip changes?

A
  • Degeneration of articular surfaces of femur or acetabulum
  • Arthritis
  • Osteochondrosis dissecans
  • Acetabular labrum tears
  • AVN
115
Q

What are S/Sx of Degenerative hip changes?

A
  • Pain
  • Referred to low back
  • Anterior thigh
  • Knee LOM in all planes
  • Decreased strength
116
Q

What are S/Sx of Ischial tuberosity bursitis?

A
  • Movement of buttocks while pt is weight bearing in seated position can irritate the bursa
  • Irritated by prolonged sitting
117
Q

What do you need to r/o before diagnosing Ischial tuberosity bursitis?

A

R/o hamstring strain or avulsion of its attachment

MSK (11 decks)

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